Clinicians' attitudes towards supplemental oxygen for trauma patients - A survey.

Introduction: The Advanced Trauma Life Support guidelines (ATLS; 2018, 10th ed.) recommend an early and liberal supplemental oxygen for all severely injured trauma patients to prevent hypoxaemia. As of 2024, these guidelines remain the most current. This may lead to hyperoxaemia, which has been associated with increased mortality and respiratory complications. We aimed to investigate the attitudes among clinicians, defined as physicians and prehospital personnel, towards the use of supplemental oxygen in trauma cases.
Materials and Methods: A European, web-based, cross-sectional survey was conducted consisting of 23 questions. The primary outcome was the question: "In your opinion, should all severely injured trauma patients always be given supplemental oxygen, regardless of arterial oxygen saturation measured by pulse oximetry?".
Results: The survey was answered by 707 respondents, which corresponded to a response rate of 52 %. The respondents were predominantly male (76 %), with the largest representation from Denmark (82 %), and primarily educated as physicians (62 %). A majority of respondents (73 % [95 % CI: 70 to 76 %]) did not support that supplemental oxygen should always be provided to all severely injured trauma patients without consideration of their arterial oxygen saturation as measured by pulse oximetry (SpO ₂ ), with no significant difference between physicians and non-physicians (p = 0.08). Based on the respondents' preferred dosages, the median initial administered dosage of supplemental oxygen for spontaneously breathing trauma patients with a normal SpO ₂ in the first few hours after trauma was 0 (interquartile range [IQR] 0-3) litres per minute, with 58 % of respondents opting not to provide any supplemental oxygen. The lowest acceptable SpO ₂ goal in the first few hours after trauma was 94 % (IQR 92-95). In clinical scenarios with TBI, higher dosage of supplemental oxygen and fraction of inspired oxygen (FiO ₂ ) were preferred, as well as targeting partial pressure of oxygen in arterial blood as opposed to adjusting the FiO ₂ directly, compared to no TBI.
Conclusion: Almost three out of four clinicians did not support the administration of supplemental oxygen to all severely injured trauma patients, regardless of SpO ₂ . This corresponds to a more restrictive approach than recommended in the current ATLS (2018, 10th ed.) guidelines.
Competing Interests: Declaration of competing interest None of the authors have any conflicts of interest to declare regarding the present manuscript. For conflicts of interests related to any entity the past 36 months not related to the present manuscript, these authors have the following to declare: Tobias Arleth received funding for a biomarker Copenhagen sub-trial of TRAUMOX2 from the Holger and Ruth Hesses Memorial Foundation and Danish Air Ambulance, and received funding for three months of research PhD programme exchange from Knud Højgaard's Foundation, the William Demant Foundation, Christian and Ottilia Brorson's Travel Scholarships, the Medical Science Faculty Foundation of Copenhagen University, and the Consultant Dr. Med. Edgar Schnohr and wife Gilberte Schnohrs Foundation. Josefine Baekgaard received funding for the TRAUMOX2 trial from the Novo Nordisk Foundation and was awarded with the prize for “talented young researcher” by The Lundbeck Foundation, of which 47.000€ was allocated to research. Stine T. Zwisler attended a Secma ultrasound course, and is an IDMC consultant for the GA Targets Trial; the author or the author's affiliation did not receive any payments in this regard. Wolf. E. Hautz received funding from the Swiss National Science Foundation and the European Union. Wolf E. Hautz received consulting fees and honorarias from the AO Foundation Zurich, and Mundipharma Switzerland gave him support for attending meetings, alongside participating in a DMSC for MDI Australia. Jacob Steinmetz receives funding of his professorship from the Norwegian Air Ambulance Foundation where payments are made to his organization, and he received funding for the TRAUMOX2 trial from the Novo Nordisk Foundation. The rest of the authors have nothing to declare.
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